Fwd: Good News, Bad News

[Guest guest]

Asclepios

Your Weekly Medicare Consumer Advocacy Update

Good News, Bad News

November 20, 2008 • Volume 88, Issue 47

The bad news is you're sick an you don't have insurance.

The good news is you turn 65 in January and your Medicare coverage kicks

in.

The bad news is you can't afford the medicines your doctor prescribed at

your “Welcome to Medicare†physical.

The good news is you qualify for Extra Help, which helps pay drug

premiums and copayments for low income people with Medicare.

Sound familiar?

Have a different story to tell?

We want to hear it and so do Congress and the media.

Health care reform is on the table for 2009. Policymakers need to hear

what works and what doesn't; what keeps people from receiving quality

care and what makes it happen. People with cancer, mental illness,

AIDS/HIV, diabetes, and physical disabilities all need to weigh in. The

stories of SHIP counselors and homecare workers, pharmacists and family

caregivers should inform the coming debate. We need to hear from school

bus drivers and systems analysts, tax accountants and plumbers (no

blowhards, please).

Tell your story about our health care system. Happy and sad endings

welcome.

Medical Record

“I am 68 years old. I took a Medicare Prescription Plan in 2006 when

they first were available. I received Extra Help, that year as determined

by Social Security. In 2007 the help was denied and I received nothing to

pay for the premiums, but continued to get my medications. I called about

the payments because I did not know what they would be. I called the

Social Security Office telling them that I was still doing the

demonstrations job but only two days per week and wanted to know why I

was no longer getting Extra Help. It's because I work two days per week.

This just throws me into making too much money. (I work to have a little

extra.) I was told that if I quit my job for 2009 I would qualify for the

Extra Help. In other words, during the 2008 year, I'm working only to pay

for my premiums and the medications. I know that I am really just

scraping by because of these additional charges.

I think there is something wrong with a system that tells someone that

if they quit their job, they will get their prescription Extra Help. I

was also told that the determination could not be changed for 2008. So I

will have the charges for the premium as well as the higher cost of my

prescriptions. I have had 4 primary cancers, having a lobe removed from a

lung, a kidney removed, cervical cancer and now they have found a

Carcinoid cancer in two lymph nodes of undetermined origin. My

prescriptions are expensive.†(Story submitted to the

Part D Monitoring Project, February 2008)

“I signed my mom up for a Medicare Advantage Plan on the premise

that her primary care physician participated in the plan. He was listed

in the book, on the website, and verified when the representative came to

the house to sign her up. Also, the benefits card she received in the

mail had his name on the card as her PCP. However, he does not

participate (as of 2005!) and she has since run up $600 in bills that the

Medicare Advantage plan will not pay. I have had MANY conversations with

the Medicare Advantage plan to resolve the issue. They insist he is on

the plan but his claims officer states their claims have been repeatedly

denied and she has worked tirelessly to try and help my mom navigate the

system. Sadly, the doctor’s office has advised us to look for a plan

doctor to take care of her. This has caused my mother MUCH anguish over

losing her trusted physician that has taken care of her for the past 20

years.†(Story submitted to the

Private Health Plan Monitoring Project, May 2008)

“Jim became eligible for Medicare in January 2007. When asked about

the difficulties of being uninsured, he said, “I tried to put off

medical care until I became eligible for Medicare, which complicated my

condition.†Jim added that asking for charity and constantly

negotiating payment plans has been “humbling and embarrassing.†“I

always had a good job with medical insurance, and never had to go through

anything like this before.†he said.

(

Too Sick To Work, Too Soon for Medicare: The Human Cost of the Two-Year

Medicare Waiting Period for Americans with Disabilities, Medicare

Rights Center, April 2007)

* * * *

Medicare Part D Appeals Help for Advocates Is

Here!

Medicare Rights Center’s new Medicare Part D Appeals: An

advocate’s manual to navigating the Medicare private drug plan appeals

process offers an easy-to-understand, comprehensive overview of the

entire appeals process, including real-life case examples, a glossary of

important appeals terms, a sample protocol for advocates, and links to

important resources.

Register for a

FREE

copy of this great resource.

* * * *

Medicare Part D Monitoring Project

The Medicare Rights Center would like to hear about your experience, or

that of someone you know, enrolled in a private drug plan. With

information about what the issues are with Medicare Part D, we will be

able to demand that those problems be fixed.

Submit your story at

http://www.medicarerights.org/partdstories.html.

* * * *

The Louder Our Voice, the Stronger Our Message

* * * *

Asclepios—named for the Greek and Roman god of medicine

who,, acclaimed for his healing abilities, was at one point the most

worshipped god in Greece—is a weekly e-newsletter designed to keeep you

up-to-date with Medicare program and policy issues, and advance advocacy

strategies to address them. Please help build awareness of key Medicare

consumer issues by forwarding this action alert to your friends and

encouraging them to

subscribe today.

* * * *

The Medicare Rights Center is a national, nonprofit consumer

service organization that works to ensure access to affordable health

care for older adults and people with disabilities through counseling and

advocacy, educational programs and public policy initiatives.

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